Medicine Library - Online Reference Guide

Every physician needs an online medicine library these days.

I know we can still use printed references like we used to do in the old days, and I still buy medical textbooks now and then and subscribe to printed medical journals. However, the amount of knowledge that is available online and the rapidity with which it can be accessed has revolutionized our ability to obtain the information we need quickly - at the point of care. This helps us make informed, evidence-based decisions much more quickly than we could do otherwise in many situations.

There are some physicians who have eidetic minds and don't seem to need to look up anything. The rest of us need references to remind us how to diagnose and treat problems that we don't see every day. Most physicians are very knowledgeable about medicine but nobody knows everything. It's impossible.

And there are always those diagnostic dilemmas that make us all scratch our heads and reach out for more information.

My Online Medicine Library

The following is a list of my favorite online medical references that I use regularly in taking care of patients on a day-to-day basis:

Up To Date (www.uptodate.com) is a very comprehensive program that you can load on one computer and access online from any computer. For internal medicine and general practice and hospitalist specialties, you can't beat it as far as completeness, reliability and speed for both diagnoses and medication monographs. Sometimes it's a little too complete to be able to access the information you need quickly. Also, it's not good at differential diagnosis of symptoms; and it's a little expensive, but probably worth it as an excellent online resource that you can access from anywhere.

MD Consult is also an excellent resource for searching for general information, looking for specific textbooks or journals to reference. It's also a little expensive. I wouldn't necessarily do both MD Consult and UpToDate. I think one or the other would be sufficient. Its sister program, First Consult, which costs a little extra, provides rapid access to the "quick and dirty" information you need right away without having to read through lots of material to get at what you want to know. This solves the problem that UpToDate can't do.

MKSAP is a program that comes out every 3-4 years and updated once or twice in between. This is a great tool for finding areas of knowledge in which you may be deficient. It's the best program you can get if you are studying for specialty board exams or recertification exams. I find it to be a little labor-intensive for everyday use however at the point of care.

Pier, an ACP program, is great for quick access to common diseases, telling what you need to ask the patient, what you need to order for diagnosis and treatment for a variety of conditions. Its' database is growing every year though there may be some unusual diseases that you won't find there. It's free to ACP members however.

Epocrates (www.epocrates.com) is an excellent free quick online reference on pharmaceuticals, giving doses, interactions, main side effects and contraindications although not much on indications or mechanisms of action. I like to keep it open on my desktop at the office to be able to access it immediately without having to sign on each time I want to use it. I like the patient handouts that are available for each drug. I print one of these out for each patient whenever I start the person on a new medication. It's easy to do, the patients appreciate it and it's good practice from a medico-legal standpoint as well. If you want to purchase the upgraded versions of this program, you can get extra tools, such as medical formulas and calculations and disease references also. There is a mobile version as well that I access from my iPhone frequently.

I also use Tarascon Pharmacopeia for drug information as part of my online medicine library. This actually seems to be a little faster to load than Epocrates on my mobile device and I don't have to sign in as frequently or wait for updates to load before I can access it which are things that slow you down a little with Epocrates.

PubMed is a fantastic resource that no online medicine library or primary care physician should be without, and it's free to access online from anywhere. It is very user friendly and can provide a search of the medical literature for almost any disease, test or treatment that's ever been studied or reported on. Recently a patient asked me if H.zoster ever was associated with the development of scoliosis. I did a PubMed search and in seconds I found an article (a case report) indicating there has been reported to be a possible association.

A list of patient references is also good to have available so you can refer your patients to accurate information on the web about their particular illnesses or conditions or even about how to learn to be physically, nutritionally and emotionally fit. The above is a link to a page from my office website that contains such information that would be helpful for patients wishing to do some online research.

You don't have to be a genius to be a good physician. Medical school will provide a very good knowledge base from which to start. Daily experiences in the clinic or on the hospital wards will provide greater knowledge and wisdom about how to take care of patients. But your general knowledge base outside of the common things you do every day will erode quickly if you don't keep up to date. If you ask yourself questions about what you're doing or not doing in your daily care of patients, and if you know where to look up that information quickly so that it's not a chore to do so, you will become a far better physician. You will be more interested in your patients and you will become even more knowledgeable. This is important for our patients and for ourselves to maintain that interest in medicine - that same enthusiasm for it that we started out with when we were students.